For former teachers only: if you have been a teacher before, please select grade levels you have taught below

ElementaryMiddleHighCollegeSpecial Education

If you selected other, please explain:

Story Sharing - Optional

Please share a
success or a change you noticed in your student(s) last year that we may share
in our program reports and materials.

Please share any
challenges you faced this year with your student(s) or school. What type go
support (if any) did you receive or would you have wanted?

Other suggestions/
thoughts/ general program comments/ requests for additional support:

Agreements Section

Photo Release:

I hereby grant the Jewish Community Relations Council of Greater Boston and its related programs (hereafter referred to as JCRC) to use my likeness in a photograph in any and all of its publications, including website entries, without payment or any other consideration.I understand and agree that these materials will become the property of JCRC and will not be returned.I hereby irrevocably authorize JCRC to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing JCRC’s programs or for any other lawful purpose.In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph.I hereby hold harmless and release and forever discharge JCRC from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.I do not permit my photo to be used in any publications print or online

Age Requirement:

I am at least 21 years of age and am competent to contract
in my own name. I have read the releases before checking the box and I fully
understand the contents, meaning, and impact of this release.

Name Recognition:

I give JCRC permission to list my name online and in print publications when recognizing volunteers’ years of service.Please do not list my name online or in any print publications.

Background Reports

I understand that the town/city where I plan to volunteer will conduct a background report (CORI) as standard practice in the State of Massachusetts. I understand I need to confirm annually with my school (or with JCRC for Boston Public Schools) that my CORI status is up to date.